Laparoscopic versus laparotomic radical en bloc hysterectomy and colorectal resection for endometriosis

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Laparoscopic radical en bloc hysterectomy and colorectal resection for endometriosis showed feasibility with less analgesic use and similar symptom improvement and quality of life compared to laparotomy.

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This single-center retrospective study compared feasibility, quality of life, and urinary function after radical en bloc hysterectomy with colorectal resection (REHCR) performed laparoscopically versus by laparotomy in 29 endometriosis patients, using validated questionnaires for gynecologic/digestive symptoms, SF-36 health status, and urinary symptoms (IPSS, BFLUTS), with a mean follow-up of 14 months (range 1–78). In the laparoscopic group, 25% underwent laparoconversion, but analgesic drug consumption was lower, and diarrhea and lower back pain improved, while dysmenorrhea, dyspareunia, asthenia, and quality of life improved with no between-group differences. Urinary function was not altered and did not differ between groups, and the authors’ main caveats include the retrospective design, single-center setting, and relatively small sample with variable follow-up. This paper is centrally about endometriosis — it directly evaluates laparoscopic versus open radical en bloc hysterectomy plus colorectal resection for extensive pelvic endometriosis.

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Abstract

Background Radical en bloc hysterectomy and colorectal resection (REHCR) is the ultimate and radical surgery for extensive pelvic endometriosis. Our aims were to evaluate feasibility, quality of life, and urinary function after REHCR by laparoscopy compared with laparotomy.

Methods

Single-center, retrospective study of 29 endometriosis patients having undergone REHCR (16 by laparoscopy, 13 by laparotomy). Gynecologic and digestive symptoms, quality of life [Short-Form (SF)-36 health status], and urinary function [International Prostate Score Symptoms (IPSS) and Bristol Female Lower Urinary Tract Symptoms (BFLUTS)] were evaluated using validated questionnaires.

Results

Except for mean age, no difference in epidemiologic characteristics was found between groups. Mean follow-up was 14 months (range 1–78 months). Four of the 16 patients (25%) of the laparoscopic group required laparoconversion. Consumption of analgesic drugs was lower in the laparoscopic group, and diarrhea (P < 0.001) and lower back pain (P < 0.001) improved. Improvement in dysmenorrhea (P < 0.001), dyspareunia (P < 0.001), asthenia (P < 0.001), and quality of life was observed without difference between groups. Urinary function was not altered and did not differ between groups.

Conclusion

Our data support the feasibility of REHCR by laparoscopy with less analgesic consumption. Efficacy in terms of symptoms and improvement in quality of life were similar between groups, suggesting that laparoscopy should be offered to patients requiring REHCR. Similar content being viewed by others

References

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Hum Reprod 21:774–781 Disclosures Authors Emile Daraï, Marcos Ballester, Elisabeth Chereau, Charles Coutant, Roman Rouzier, and Estelle Wafo have no conflicts of interest or financial ties to disclose. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Daraï, E., Ballester, M., Chereau, E. et al. Laparoscopic versus laparotomic radical en bloc hysterectomy and colorectal resection for endometriosis. Surg Endosc 24, 3060–3067 (2010). https://doi.org/10.1007/s00464-010-1089-8 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00464-010-1089-8

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Condition tags

mesh:D004715endometriosis

MeSH descriptors

Colonic Diseases Endometriosis Hysterectomy Laparoscopy Laparotomy Rectal Diseases Adult Colonic Diseases Endometriosis Female Humans Hysterectomy Middle Aged Rectal Diseases Retrospective Studies

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